Clinical Pearls, 13-Mar-1998. The big news in medicine this week was the publication of a study that found high salt intakes to be correlated with longevity. This contradicts standard medical advice to decrease dietary salt intake in order to lower blood pressure. This study contained a lot of confounding variables, and the effect was small. Those with salt intakes in the highest quartile had a death rate of 19 deaths per 1,000 person-years, compared with 23 deaths per 1,000 person-years in those people in the lowest quartile of dietary salt intake. Guess what? Moderation seems to be the best advice! This age old wisdom continues to stand the test of time.

In a related issue challenging standard medical advice, scientists are wondering whether a low cholesterol level is associated with violent behavior. Evidence continues to support the notion that low cholesterol levels are actually harmful. Cholesterol acts as a cell membrane stabilizer, and the theory is that when cholesterol levels are too low, cells in the brain are adversely affected. The result, according to the theory, is a lowered brain serotonin activity, leading to a higher rate of death from violence (usually defined as homicide, suicide, or accidents). But just what is a "low" cholesterol level? That remains mysterious, but some studies have defined it as a level below 160 mg/dL.

The number of new cases of cancer in the US population declined by an average of 0.7% annually from 1990 to 1995. This compares to an average annual INCREASE of 1.2% yearly from 1973 to 1990.

Recommended reading this week is Psycho-Cybernetics by Maxwell Maltz, M.D. This classic book on using your mind as a tool in the healing process was written by a plastic surgeon. Dr. Maltz found that even after facial scars and other deformities had been surgically corrected, many patients continued to complain of being ugly or unattractive in some way. He realized that the person's self image often played a bigger role in the healing process from plastic surgery to correct deformities from facial trauma. Over and over again, we are finding that the mind has a significant influence upon the healing process, and Maltz's book describes practical and effective ways to use and control your mind. An update of this book written by one of his students is also highly recommended. In Psycho-Cybernetics 2000 by Bobbe Sommer, Dr. Maltz's techniques are further refined and new methods of making your thoughts work for you are introduced in an easy to read and understand manner.

Another great book on human cybernetics by U.S. Anderson is Success Cybernetics. This is a hard hitting, down to earth book on cybernetics written by a former professional football player. The best work on how the mind can be your greatest ally in the healing process, however, is the landmark book by Norman Cousins, Anatomy of an Illness. If you are challenged by any physical illness, you should make reading this book a top priority. Norman Cousins book is a true classic, and on my required reading list for doctors, nurses, and everyone involved in the healing professions. Get the hardback edition since the cost difference is minimal and because this is a book you'll want to keep in your personal library.

Now for the pearls of the week---

Low dose aspirin has been recommended by the American
Diabetes Association to help prevent heart attacks in
diabetics over 30 years old. American Diabetes
Association. Diabetes Care, NOV 1997, 020:1772.

Among smokers who want to quit, sustained release
bupropion (Zyban) approximately doubled the quit rate
compared to placebo: at 1 year the placebo group had a
12% quit rate compared with a 23.1% quit rate among those
who used Zyban for 7 weeks at 300 mg/d Hurt RD ... NEJM,
23-OCT 1997, 337:1195.

In men who ate fish at least once a week, compared
with those who ate fish less than once a month, the risk
of sudden cardiac death was significantly reduced (by
about 50%, controlled for age, asa, risk factors) .
Total mortality was also reduced. Albert CM ... JAMA,
7-JAN 1998, 279:0023.

In this study of 742 adults with signs and symptoms
suggestive of a pulmonary embolus (PE), the D-Dimer blood
test was 99.5% sensitive in detecting a PE. The specificity
was 41.4% Perrier A ... Am J Respir Crit Care, 1997,
156:0492.

In this study of 612 patients with an acute pulmonary
embolism (PE), treatment with low molecular weight heparin
was as safe and as effective as standard therapy with
unfractionated heparin. Simonneau G ... NEJM, 1997,
337:0663.

Antibiotics are of little to no benefit in the
treatment of acute maxillary sinusitis. van Buchem FL ...
Lancet, 1997, 349:0683.

In this rehash of the NHANES data, those in the highest
quartile of salt intake had a lower risk of death than
those in the lowest quartile (19 vs 23 deaths per 1,000
person-years). Lancet, 1998, 351:0781.

Children of smokers have both an increased rate of
illness AND death. In the US, annually there are an
estimated 5 million excess pediatric illnesses and 6200
excess pediatric deaths due to parental smoking.
Aligne CA ... Arch Pediatr Adolesc Med, 1997, 151:0648.

In this study of 3397 Swedes, the use of calcium
channel blockers was associated with an increased suicide
rate. Lindberg G ... BMJ, 7-MAR 1998, 316:0741.